1083778385 NPI number — HUDSON RIVER HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083778385 NPI number — HUDSON RIVER HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON RIVER HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083778385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 BROWN ST
Provider Second Line Business Mailing Address:
4TH FLOOR - CREDENTIALING
Provider Business Mailing Address City Name:
PEEKSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10566-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-734-8600
Provider Business Mailing Address Fax Number:
914-734-8745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 PILCH STREET
Provider Second Line Business Practice Location Address:
HUDSON RIVER HEALTHCARE, INC.
Provider Business Practice Location Address City Name:
PINE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-398-1100
Provider Business Practice Location Address Fax Number:
845-398-7108
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOLON
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
914-734-8747

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00473038 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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